Excessive alcohol use and persistent smoking have both been found independently to have a deleterious impact upon prospective memory (PM: memory for planning and executing future activities) and executive function (EF: the control of attention in memory) in the past.

The present study examined whether those who simultaneously drank alcohol and smoked were at greater risk of PM and EF deficits compared with an alcohol-only group and a zero-substance user group.

Anyone reporting using illegal substances (e.g. ecstasy/cannabis) were excluded. 23 poly-drug users (PD: those who drank and smoked), 27 single drug users (SD: who only drank alcohol) and 29 zero-users (ZU: who did not use any recreational drug) were compared on measures of anxiety, depression, PM and EF. PM was measured using a virtual reality PM task (VRPMT) in which the participant had to recall specific activities at particular locations when navigating though the computer-based virtual reality ‘office’ environment. EF was measured using the Reverse Digit Span (RDS) which required the participant to recall increasing numbers of digits in reverse order.

There were no significant between-group differences in terms of gender, age, alcohol use (PD and SD only), anxiety, or depression scores. The PD group performed the worst on the VRPMT and RDS tasks; followed by the SD group; with highest performance on these tasks being observed in the ZU group.

Combined drinking and smoking produces a kind of ‘double whammy effect’ on PM and EF, compared with single drug-use and zero-user groups.

Independent studies have observed that persistent cigarette smoking is associated with impairments in executive function (EF: the manipulation of information in memory) and prospective memory (PM: remembering future plans and intentions). However, no research to date has considered whether deficits both sets of functions are exhibited in the same cohort of current smokers - which one would expect given that both EF and PM are intimately related.

The present study examined whether EF and PM deficits were evident in the same cohort of current smokers when compared with a neversmoked group.

A group of current smokers (CS; N=24) were compared with a control group who had never-smoked (NS; N=24). Scores on the Reserve Digit Span Task (RDST) and the Cambridge Prospective Memory Test (CAMPROMPT) constituted the dependent factors. Age, mood, other drug use and IQ were also measured since these are known to impact upon memory independent of smoking status.

After omitting anyone using an illegal substance (e.g. ecstasy or cannabis) and after observing no between-group differences on age, gender, anxiety, depression, alcohol use and IQ, the CS group performed significantly worse on the RDST and recalled significantly fewer Time-Based and Event-Based tasks on CAMPROMPT, compared the NS group.

Both EF and PM functions are evident in the same cohort of chronic smokers when compared with a never-smoked group. These functions share common resources in the brain and it is feasible that persistent cigarette smoking damages those regions of the brain underpinning these shared resources.

Sharing personal experiences and survival mechanisms about challenging conditions such as Autism on YouTube may be useful to other parents, educators, psychologists, and policy makers.

This study aimed at analysing YouTube videos of parents sharing their experiences about Autism and text comments posted by viewers.

During the period from 15 November to 15 December, 2012. YouTube was researched by three assessors for videos covering parents sharing their experiences about Autism. Only relevant videos in the English language were identified. For each video, the following information were collected: title, authors, duration, number of viewers, and total number of days on YouTube. Using criteria comprising content, technical authority and pedagogy parameters, videos were rated independently by three assessors and grouped into educationally useful and non-useful videos. A critical thematic analysis of comments posted on was conducted.

A total of 834 videos were screened and only 128 were found to be relevant to parents sharing their experience. Further analysis revealed that 105 (82.1%) provided useful information; scoring (mean ± SD, 15.5 ± 0.94). The other videos 23 (17.9%) were not useful educationally, scoring (11.9 ±2.87). The differences between these two categories were significant; p <0.001. An aggregate of 2393 text comments was posted to useful videos and 951 to non-useful videos.

Despite the variability in the quality of YouTube videos, there are good videos covering parents’ experiences about Autism that can be used by other parents, publics, and professional bodies. The comments made by viewers reflect the importance of the emerging social media tools such as YouTube in sharing experiences.

Depression symptoms contribute to significant morbidity and health care utilization. Healthcare reform should consider improvements in clinical outcomes as well as decreased overall utilization as mechanisms to control health care costs.

The aim of this study was to determine the impact of remission on outpatient clinical visits by depressed primary care patients in collaborative care management (CCM) or usual care (UC). The hypothesis was that depressed patients with worse outcomes at six months would have increased outpatient visit counts, regardless of treatment type.

The study was a retrospective, chart review analysis of 1,733 patients with six month follow-up data. The data set included baseline data (demographic information, diagnosis, medical comorbidity, prior outpatient visit counts and depression severity) and six month follow up data (PHQ-9 scores and number of outpatient visits utilized).

Multiple logistic regression demonstrated that remission at six months was an independent predictor of outpatient visit outlier status (>8 visits) (OR 0.609 CI 0.460-0.805, p<0.01), when controlling for all other independent variables. The odds ratio of being an outpatient visit outlier status for those patients NOT in remission at six months was the inverse of this at 1.643 (CI 1.243-2.173).

In primary care patients treated for depression, successful treatment to remission at six months decreased the likelihood of the patient having more than 8 visits during the six months after diagnosis. This holds true even when controlling for the individual patient's prior outpatient visit counts, health care comorbidities and enrollment into CCM vs. UC.

Prior studies have demonstrated an inter-relationship between the diagnosis of diabetes, obesity and depression. Our data has demonstrated that baseline body mass index (BMI) was not predictive for clinical outcomes (remission at six months). Does either obesity or diabetes impact initial depression severity?

Our hypothesis was that obesity and the diagnosis of diabetes in depressed primary patients would have no effect on initial depression severity at the time of diagnosis of depression.

This study was retrospective analysis of 4,310 primary care patients diagnosed with Major Depressive Disorder or Dysthymia with a PHQ-9 score of 10 or greater.

1. ▪ Outcome variable was initial depression severity at the time of diagnosis (as measured by PHQ-9).

2. ▪ Logistic regression modeling included the demographic variables of age, gender, marital status, the clinical variables of BMI, diagnosis of diabetes (yes/no) and clinical diagnosis (recurrent or first episode of depression, or dysthymia).

Figure 1

Odds ratio for severe depression (PHQ-9≥20) at diagnosis in depressed primary care patients, by variable (N=4,310).

1. ▪ Baseline obesity was not an independent predictor for severe depression.

2. ▪ Diagnosis of diabetes was an independent predictor for as protective for severe depression at diagnosis.

This data suggests that obesity was not associated with worsening depression severity; diabetes may be seen as protective if patients were being seen sooner and diagnosed earlier in their disease course.

Prior studies have demonstrated an inter-relationship between the diagnosis of diabetes, obesity and depression. Our data has demonstrated that baseline body mass index (BMI) was not predictive for clinical outcomes (remission at six months).

Our hypothesis was that obesity (BMI ≥30) and the diagnosis of diabetes in depressed primary patients would have no effect on depression remission rates six months after diagnosis.

This study was retrospective analysis of 1, 894 primary care patients diagnosed with Major Depressive Disorder or Dysthymia with a PHQ-9 score of 10 or greater.

1. ▪ Outcome variable was clinical remission (PHQ-9 < 5) at six months.

2. ▪ Logistic regression modeling included the demographic variables of age, gender, marital status, the clinical variables of BMI, baseline PHQ-9 score, diagnosis of diabetes (yes/no) and clinical diagnosis (recurrent or first episode of depression, or dysthymia).

Figure 1

Odds ratio for clinical remission (PHQ-9<5) at six months in depressed primary care patients, by variable (N=1,894).

Controlling for age, gender, marital status, race, clinical diagnosis and clinical site with logistic regression modeling.

1. ▪ Baseline obesity was not an independent predictor for depression outcome at six months.

2. ▪ Diagnosis of diabetes was not an independent predictor for depression outcome at six months.

This data suggests that obesity and diabetes were not associated with worsening clinical outcomes in depression management.

Prior studies have demonstrated an inter-relationship between the diagnosis of diabetes, obesity and depression. Our prior studies have shown that the diagnosis of diabetes or baseline body mass index (BMI) did not impact six month depression remission rates.

Our hypothesis was that level of control of diabetes (hemoglobulin A1c < 8.0%) in depressed diabetic patients would have no effect on depression remission rates six months after diagnosis.

This study was retrospective analysis of 451 diabetic primary care patients diagnosed with Major Depressive Disorder or Dysthymia with a PHQ-9 score of 10 or greater.

1. ▪ Outcome variable was clinical remission (PHQ-9 < 5) at six months.

2. ▪ Logistic regression modeling included the demographic variables of age, gender, marital status, the clinical variables of BMI, baseline PHQ-9 score, hemoglobin A1c level (at date of diagnosis of depression) and clinical diagnosis (recurrent or first episode of depression, or dysthymia).

78.5% (354) of depressed diabetics were in good control of diabetes (hemoglobin A1c< 8%) at enrollment. Obesity (BMI≥ 30) at baseline was not different between the controlled and uncontrolled diabetic patients at baseline (approximately 70%), p=0.36.

Figure 1

Odds ratio for clinical remission (PHQ-9<5) at six months in diabetic primary care patients, by variable (N=451).

Controlling for age, gender, marital status, race, clinical diagnosis and clinical site.

1. ▪ Baseline control of diabetes was not an independent predictor for depression outcome at six months.

This data suggests that poor diabetic control was not associated worsening clinical outcomes in depression management.

Current study aimed to investigate self esteem and attitude toward Appearance schema in patients with rhinoplasty.

In this pretest-posttest semi-experimental design, sample population was consisted of total patients who refered to AmirAlam hospital and a private doctor office for rhinoplasty during the first six-month of 2010. Sampling method was convenient which based on 2 patients per week; the sample size was estimated as 40 persons. The study scales were a demographic questionnaire included variables like age, sex, education, job and the number of rhinoplasty operations. Also, Cooper smith inventory and Appearance schema inventory were used for data gathering.

The sample was 40 patients whom 27.5% were male and 72.5% were female. Also 77.5% of them were singles and others were marries. 5% had lower diploma education level, 25% diploma and others had university degrees. Results showed rhinoplasty could not change their self esteem but the scores of attitude toward Appearance befor and after sergury were different (0.05≥p? 39=df? 3.012=t)

Before rhinoplasty operation, patients should be assessed psychologically and in should be considered that before rhinoplasty, psychological factors play an important role on increasing self esteem and promoting attitude toward Appearance.

Parkinson's disease is one of the most disabling neurological diseases; however much progress has been made in the treatment of drug resistant patients through electrode implantation and stimulation of the subthalamic nucleus (STN). This new neurosurgical method may lead to some neuropsychological side effects in patients. The main aim of this study was to evaluate the neuropsychiatric effects of this treatment.

This case-control study was designed to compare two groups of patients with Parkinson's disease. Thirty patients who underwent electrode implantation and deep brain stimulation were compared with 60 patients treated with antiparkinson drugs. These two groups were matched for age, sex, duration and severity of Parkinson's disease.

The UPDRS was used to assess the severity of Parkinson's disease. The Beck Depression Inventory questionnaire and the Hamilton Anxiety Rating Scale were used to evaluate depression and anxiety as a consequence of DBS. The Mini Mental Status Examination and Clock Drawing Test (CDT) were used to evaluate the cognitive and executive function.

Thirty months after STN stimulation, a lower level of anxiety and depression were seen in the DBS patients compared with drug treated subjects, but the differences were not significant. However, cognitive status deteriorated to a greater extent in study subjects compared to the control group. The MMSE results were not significantly different, but the differences in CDT scores were significant.

Patients who have undergone DBS surgery must be followed up for neuropsychiatric symptoms, particularly for subcortical cognitive deterioration in the long term.

In Mental Health inpatient settings, we are working with a population with high levels of physical morbidity. However, this remains an area where Psychiatrists and Mental Health Nurses can lack confidence in the necessary skills. In other disciplines, simulation has provided an opportunity for safe practice of these and other skills. We describe the genesis and regional development of a multidisciplinary clinical simulation course that looks specifically at such ‘medical’ problems.

By the end of this presentation, the audience will: understand the rationale for the RAMPPS course; understand the development of the project; and understand the tangible benefits.

We aim to demonstrate that practising these assessment and initial management skills in a safe, controlled setting can result in improvements in confidence amongst healthcare professionals.

We have constructed a number of scenarios based upon real-life serious untoward incidents from inpatient wards. Using high-fidelity manikins, part-task trainers and actors, we produce realistic scenarios where Health Care Assistants, Staff Nurses and Doctors are all expected to work together. Learning objectives are mapped to relevant professional curricula.

Each professional group reports improvements in confidence across a number of domains. This is borne out in qualitative and quantitative data. Participants appreciate the value of training with colleagues from other disciplines, and feel peers would benefit from similar training.

Simulation is relatively underused in mental health. We demonstrate a way in which this educational approach can lead to improved confidence in managing deterioration in physical health in our inpatient population.

Angioedema is a rare but potentially life-threatening adverse effect of antipsychotics. The late-onset angioedema is a rare clinical condition which occurs months or years after.

To describe the case of a female patient who developed late-onset angioedema following treatment with clozapine after 5 years and redevelopment of angioedema with introduction of olanzapine which resolved on discontinuation of both drugs.

A case report

27-year-old woman was diagnosed with psychotic disorder and mental retardation five years ago. Her clinical condition was going well with clozapine 150 mg/day. At one of her follow-up visits, the physical examination revealed swelling over the face and eruption on perioral region. A diagnosis of ‘acute angioedema’ was established. After discontinuation of clozapine, skin symptoms were resolved within one week and olanzapine was started. Few days after introduction of olanzapine, the same skin symptoms emerged over the face and repeated laboratory tests were unremarkable. Skin scratch test revealed hypersensitivity with the medications of clozapine, olanzapine and sulpiride. Olanzapine discontinued and quetiapine 900 mg/day was started. She remained well under quetiapine therapy without any recurrence of psychiatric symptoms or angioedema.

To our knowledge, this is the first reported case of late-onset angioedema due to clozapine monotherapy. This case report indicates the need for clinicians to be aware of late-onset adverse events in patients treated with antipsychotics.

Hyperbradykininemia was reported in case of angioedema and dry cough as an adverse effect of angiotensin-convertingenzyme (ACE) inhibitors. There is a possibility that the choking sensation, shortness of breath, or smothering sensation in anxiety nurosis could be induced by bradykinin (BK). We sought to examine plasma-BK concentration of Generalized Anxiety Disorder (GAD) and postulated a new concept of anxiety disorders.

We identified 11 GAD patients. All subjects had signed written informed consent. We measured inflammatory markers (WBC, ESR, CRP), C1-inhibitor activity and circulating BK (normal values : < 10.0 pg/ml). Anxiety was measured using the Hamilton Anxiety Rating Scale (HAM-A).

No abnormalities were found in WBC, ESR, CRP and C1-inhibitor activity. There were substantial rises in BK in GAD with a mean plasma-BK concentration of 100.1 pg/ml (SD=44.6). There was a significant correlation between HAM-A and plasma-BK concentration in the 11 GAD patients, expressed by the regression: BK=5.10(HAM-A)-51.5, r=0.62, p<0.05.

11GAD patients did not have any focal infection but presented hyperbradykininemia and free-floating anxiety. The symptoms of free-floating anxiety could be explained by the nature of BK which acts to produce pain, vasodilation, increased vascular permeability, and synthesis of prostaglandins. Therefore, GAD may be termed a diffuse nociceptive state, or an incomplete inflammatory state uncoupling from other inflammatory markers.

We would like to consider a single model which posits that hyperfunction of suffocation receptors in the lung could be the cause of Panic Disorder (PD).

The pulmonary neuroepithelial bodies (NEBs), which are situated at the bifurcation point of small bronchi, act as O2 sensors responding to a number of airway stimuli, including hypoxia, hypercapnia, and smoking, and release 5-hydroxytriptamine (5-HT) from their secretory granules. If we suppose that PD might represent an inflammation of the NEBs, bradykinin (BK) which augments the airway hyperresponse to diverse inducers might cause these cells to release 5-HT along with peptides and panneuroendcrine markers from their secretary granules.

Since it was revealed that BK with 5-HT could cross the blood-brain barrier (BBB), when 5-HT released from NEBs along with BK cross the BBB, the serotonergic neurons will be inhibited by the 5-HT1A autoreceptors. It is easy to suppress the periaqueductal gray (PAG), which inhibits flight reactions to impending danger, pain or asphyxia. In short, the hyperfunction of inflammatory NEBs might bring about panic reactions.

PD could be a lung desease that affects the brain directly and reversibly through the effects of 5-HT with BK. Future therapies for PD might be inhalants that can stabilize inflammatory NEBs, inhibit 5-HT release and BK receptors.

Dyslexia is a reduced reading comprehension despite normal IQ. This may affect sufferers’ ability to be competitive in high end degrees. We investigated the prevalence of dyslexics in 4 degree disciplines.

4 cohorts were analysed consisting of Engineering, Medical, Law, and Dentistry students. These were all students drawn from UK universities. They were polled, voluntarily through an online resource. Qualitative and Quantitative data was collected and analysed. Due to data collection being by way of a poll, ethical approval was not required

18 Engineering, 46 Medical, 22 Law and 11 Dentistry students responded. Of these 5/18 (28%) Engineering students classified themselves as dyslexic in comparison to 7/46 (15%) Medical students, 1/22 (5%) Law students and 1/11 (9%) of Dentistry students. Qualitative analysis showed the importance of teachers in the pre university years. Students felt they benefited from extra time in exams and that this ‘leveled the playing field’.

This study is limited by self-reporting of dyslexia, and the potential for respondent empathy to the subject.

This study highlights a larger than previously reported prevalence of dyslexia in high performing disciplines, markedly Engineering. Other studies have focused on dyslexics IQ-reading gap, and our results support this, with Law – a literature intensive subject, actually having the lowest prevalence. Engineering focusses on mathematic methods, and the increased dyslexic prevalence suggests they are more comfortable with subjects not focused on reading.

To investigate psychiatric implications of aesthetic surgery on adolescents.

Aesthetic surgery is carried out on adolescents for many reasons, often with a central aim being to aid their social inclusion and interaction. However there is anecdotal evidence that suggests stigma associated with this causes psychiatric repercussions for the children alter in life

4 patients who had undergone aesthetic surgery due to trauma in their adolescent years were interviewed. Their responses were then qualitatively analysed. This was approved by Meducation ethics committee.

3 of the patients felt that the surgery had benefitted them and that they had adequate psychiatric support to deal with the impact of the surgery, 1 didn’t. All patients feel they have current impaired mental health as a result of having the surgery. All 4 feel this is not as bad as if they had not had the surgery. We also investigated the way they spoke about their surgery, and found the 1 patient who had not received psychiatric support was more outspoken regarding the surgery, in comparison to the other 3 patients more composed responses.

Long term psychiatric outcomes of adolescent patients undergoing aesthetic surgery for trauma injuries are improved with postoperative psychiatric support.

‘Werther effect’ is a term synonymous with suicide clusters, following a trend for suicide instigated by a historic book. Depending on cluster size, they can be named’point’ or’mass’ clusters. These phenomena, typically affecting adolescents, can have substantial emotional consequences for a community. There is a paucity of comprehensive literature in this area, hence our aim was to investigate cluster triggers and demographics.

A comprehensive review using a PubMed search was undertaken. Search terms were’suicide cluster’,’recent suicide’ and’suicide outbreaks’. As this was a review paper ethical approval was waived.

Saman et al (1992) describe two ‘high risk’ spatial clusters which translated to a 38% increase in relative suicide risk. They also describe how suicide method is remarkably consistent within a cluster supported by Exeter and Boyle (2006). Qi et al (2006), in comparison to Saman et al, demonstrated how clusters may have variable risk groups, with differing correlations between age of females and suicide rates. All studies highlighted the central part media played in commencement of suicide clusters.

With globally increasing levels of mental health issues, the recession and other demands of 21st century living, rates of suicide could increase and knowledge in this area is therefore vital at the level of government resource allocation and for the health care professionals delivering care on a daily basis. We found a strong correlation with media exposure and subsequent suicide clusters.

A sound working knowledge of the neurosciences is essential for a functional psychiatrist. It is, however, a subject renowned for being difficult for students to understand. This study investigated the benefits of peer to peer teaching in psychiatry, as either an adjunct or replacement to areas of the current curriculum.

Medical students from throughout UK were invited to respond to an online poll provided through a free to use educational interface for medical students. Questions were designed to give both quantitative and qualitative results. Ethics approval granted by Me ducation.

Data collection took part over 2 days, during which time total visitors to the site were 624. Of these 378/624 clicked the link to the external questionnaire, and 192/624 (31%) filled out the questionnaire.

Quantitative data suggested students no benefit in direct peer to peer teaching 145/192 (76%), but felt exchanging of resources is of benefit 178/192 (93%). Further analysis demonstrates a lack of centrality for such resources.

Qualitative data goes on to prove Psychiatry is a subject considered by students to be ‘hard gain’. This relates to students having to study longer to achieve a similar mark for a subject considered ‘middle or low gain’.

It is important for students to feel supported in subject areas they feel less confident. This could UK wide student resource sharing. Student produced neurology teaching resources should be made available on a UK wide level on an open access website to support student development in the psychiatry.

the objective of the present study was to examine the clinical correlations of unawareness of mental disorder in psychotic patients.

The clinical symptoms using the Positive and Negative Symptoms Scale (PANSS), demographic data and unawareness of mental disorder (SUMD) for the 120 psychotic patients was evaluated.

the psychotic patients were significantly different in insight quality. Data analysis revealed that unawareness of mental disorder has significant correlations with positive symptoms and thought disturbance. There was no significant correlation between depression and unawareness of mental disorder. Investigation of dimensions of unawareness of mental disorder with all clinical variables in psychotic patients separately, show different results.

the results show that quality of unawareness of mental disorder is different in psychotic patients. Subcomponents of unawareness of mental disorder are influenced by different factors (such as positive and negative symptoms) emphasizing the need to consider insight as multidimensional.

Juvenile Idiopathic Arthritis (JIA) describes arthritis occurring under the age of 16. Pain has long been acknowledged to be associated with psychiatric morbidity. There is a paucity of psychiatric research into the long term outcomes and management benefits for this cohort. Hence we aimed to review what was currently known, to enable a thorough research study to take place.

PubMed search was carried out using search terms’JIA and psychiatry’,’Arthritis and psychology’,’long term effects of JIA’,’JIA psychiatric management’. The papers sourced were ranked in accordance with ICJME guidelines and reviewed. Ethics was waived as this is a review.

The findings highlight a high prevalence of depression in amongst JIA sufferers, with 50% experiencing depression into adult life. Somatoform disorders are also more common in JIA sufferers. Currently there is no uniform management strategy integrated into the JIA package, although it is considered more than we hypothesised.

This review thus emphasises the necessity of ensuring paediatric psychiatric management is within the care package offered to JIA patients, particularly as our paper discusses how 50% of patients continue to have symptoms in their adult life, thus impacting on their long term psychiatric status.